To Study Clinico-Radiological Profile of Multi-Drug Resistant Tuberculosis Patients

Drug resistance is a threat to TB control program worldwide. Patient infected with multiple drug resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug resistant strains are more prone to treatment failure, progresses to more chronic forms of the disease and death. In most areas of the world, the routine use of drug susceptibility tests, let alone cultures to diagnose tuberculosis or multidrug resistant tuberculosis is beyond the scope of health care resources. According to Global Tuberculosis Report 2015, about 3.3% of newly diagnosed patients had multidrug resistant tuberculosis and 20% of previously treated Tuberculosis cases were estimated to have Multidrug resistant Tuberculosis (MDR-TB). This present study was conducted in the department of chest and TB, Government medical college, Amritsar, with an aim to study the clinico-radiological profile of patients with multidrug resistant tuberculosis. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 100 diagnosed patients of Multidrug Resistant Tuberculosis. Clinicoradiological profile of these patients was determined. Results: Out of 100 study population, maximum number of patients belonged to the age group of 21-30 years i.e. 26% followed by 22% in the age group of <20 years. Most common symptom was cough with expectoration which was present in 94 (94%) patients. 97 (97%) patients were having previous history of ATT, 3 (3%) patients were not having any previous history of ATT. On radiology unilateral disease was present in 48 (48%) patients, bilateral disease present in 52 (52%) patients. Parenchymal infiltration was present in 79 (79%) patients. Cavitation was present in 23 (23%), Fibrocavitary disease was present in 37 (37%) study subjects. Previous history of ATT had significant association with extent of lesion on chest x- ray (p < 0.05). Conclusion: clinico-radiological characteristics should always be determined where appropriately administered drugs have not achieved necessary drug levels to deal with all the population of mycobacteria, to timely modify and strengthen the national programs, and evaluation of trends in drug resistance pattern.

To Study The Percentage of HIV Seropositivity in Smear Positive Tuberculosis Cases

Tuberculosis is the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries and accounts for about 40% of all manifestations seen in HIV patients. Correct diagnosis and treatment of tuberculosis helps to reduce burden of TB. However there are difficulties in achieving this goal such as difficulties in diagnosing tuberculosis in HIV infected patients due to unusual clinical picture with increase in smear negative AFB pulmonary tuberculosis and atypical findings on chest radiography. There is a paucity of literature regarding determination of percentage of HIV seropositivity in smear positive tuberculosis cases in Northern India. Hence, this study was planned to study the correlation and burden of HIV seropositivity in smear positive tuberculosis cases. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 150 smear positive tuberculosis cases. HIV seropositivity was determined in all the patients. Results: In our study, the HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India. Conclusion: The HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India.

Tuberculosis in HIV co-infected patients- a study at tertiary care hospital, Amritsar (India).

Background: The dual epidemic of tuberculosis and HIV is a significant problem in the developed and developing countries. Tuberculosis is the most common human immunodeficiency virus related opportunistic infection in India and caring for patients with both diseases is a major public health challenge. Aim: The aim of the present study was to record the different clinical patterns of tuberculosis in HIV co-infected patients as a function of CD4+T cell count. Material and Methods: The study was a retrospective analysis of the HIV-TB co-infected patients admitted in the Chest and TB Hospital, Government Medical College, Amritsar (Punjab) during the calender year 2011. Results: Out of total 47 HIV sero-positive patients (n=47), 36 were males (76.59%) and 11 females (23.41%) of age group 14 to 51 years. Cough was the most common presenting symptom (72.34%).A large number of patients were diagnosed as having pulmonary tuberculosis (48.94%). The other diagnoses were tubercular meningitis (n=4), pleural effusion (n=4), tubercular lymphadenopathy (n=2), pneumothorax (n=2), hydropneumothorax (n=2) and abdominal tuberculosis (n=2). A total of 34 (72.34%) patients were having a CD4+T cell count of < 200. Conclusion: The manifestations of tuberculosis in HIV infected patients are quite varied and generally show a different pattern as a function of CD4+ T cell count. Co-infection with HIV infection leads to difficulties in both diagnosis and treatment of tuberculosis. High degree of suspicion of tuberculosis, with astute clinical and laboratory evaluation is the key for early diagnosis and management.